Utility of endoscopic ultrasound-guided fine-needle aspiration of regional lymph nodes that are proximal to and far from the primary distal esophageal carcinoma

// Yusuke Shimodaira 1 , Rebecca S. Slack 2 , Kazuto Harada 1 , Manoop S. Bhutani 3 , Elena Elimova 1 , Gregg A. Staerkel 4 , Nour Sneige 5 , Jeremy Erasmus 6 , Hironori Shiozaki 1 , Nikolaos Charalampakis 1 , Venkatram Planjery 1 , Dilsa Mizrak Kaya 1 , Fatemeh G. Amlashi 1 , Mariela A. Blum 1 , Heath D. Skinner 7 , Bruce D. Minsky 7 , Dipen M. Maru 5 , Wayne L. Hofstetter 8 , Stephen G. Swisher 8 , Jeannette E. Mares 1 , Jane E. Rogers 9 , Quan D. Lin 1 , William A. Ross 3 , Brian Weston 3 , Jeffrey H. Lee 3 and Jaffer A. Ajani 1 1 Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 2 Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 3 Department of Gastroenterology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 4 Department of Anatomic Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 5 Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 6 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 7 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 8 Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA 9 Department of Pharmacy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA Correspondence to: Jaffer A. Ajani, email: // Keywords : esophageal carcinoma, fine-needle aspiration, endoscopic ultrasound, upper mediastinal lymph nodes, positron emission tomography Received : March 15, 2017 Accepted : April 17, 2017 Published : May 23, 2017 Abstract Implications of assessing the proximal and far para-tracheal or sub-carinal nodes (para-tracheal [PTN] or sub-carinal [SCN]) associated with lower primary esophageal carcinomas (ECs) are unclear. To evaluate the value of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) for PTN and SCN, we analyzed results by positron emission tomography (PET) avidity, 4 EUS node malignancy features, and EUS-FNA results in all patients with Siewert’s I or II EC. Of 133 patients (PTN, n =102; SCN, n =31) with EUS-FNA, 47 (35%) patients had malignant node, leading to treatment modifications. EUS-FNA diagnosed significantly more patients with malignant nodes ( p =0.02) even when PET and EUS features were combined. Among 94 PET-negative and EUS-negative patients, 9 (10%) had malignant EUS-FNA. At a minimum follow-up of 1 year, only 3 (5%) of 62 patients with benign EUS-FNA had evidence of malignancy in the nodal area of prior EUS-FNA. Patients with malignant EUS-FNA independently had a much shorter overall survival (OS) than those with benign EUS-FNA ( p <0.001). Our data suggest that a benign EUS-FNA is highly accurate and need not be pursued further. However, malignant EUS-FNA of PTN/SCN was independently prognostic, conferred a shorter OS, and altered the management of 35% of patients.